Background We sought to determine the extent and appropriateness of benzodiazepine use in an elderly community, by measuring prevalence and incidence of benzodiazepines and examining mental health status as a predictor of benzodiazepine use.

Method Data were collected from two longitudinal studies of people from the same community, sampled in 1982-1983 and again in 1989-1991.

Results Benzodiazepine prevalence did not decrease during the period under study, butthere was a significant reduction in anxiolytic use.

Prevalence of benzodiazepines in women is twice that in men, and incidence of hypnotics is slightly higher in women.

Prevalence and incidence of hypnotics are strongly associated with increasing age.

There were high proportions of long-term users (61 and 70%), and continued use was high (52%) among new users.

A large proportion of benzodiazepine use was by those who were concurrently depressed.

Similarly, anxiety predicted both current and subsequent use of hypnotics.

Conclusions Many older people still use benzodiazepines, contrary to official guidelines with regard to their mental health.

Our findings add to the weight of opinion that persistent and long-term use should be discouraged.

Declaration of interest Analysis was supported by a grant from Lilly Industries plc.